Permit (16) CITY OF TIGARD MECHANICAL PERMIT
1114- , COMMUNITY DEVELOPMENT Permit#: MEC2019-00047
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/21/2019
7 I ''�I=.�� g Parcel: 2S111BCO2603
Jurisdiction: Tigard
Site address: 10310 SW CANTERBURY LN
Project: WCCCA Canterbury Subdivision: TIGARDVILLE HEIGHTS Lot: 7
Project Description: Installing new fuel line between new propane tank and new generator.
Contractor: DAY WIRELESS SYSTEMS Owner: TIGARD, CITY OF
4700 SE INTERNATIONAL WAY 13125 SW HALL BLVD
MILWAUKIE, OR 97222 TIGARD, OR 97223
PHONE: 503-780-5524 PHONE: 503-718-2591
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 01/31/2019 $115.11
Class of Work: ALT Type of Const: VB Plan Review 01/31/2019 $28.78
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Mechanical 01/31/2019 $13.81
Stories: Info Process/Archiving-Sm$0.50(up to 01/31/2019 $7.50
Project Valuation: $2,000.00 11x17)
Fuel Air Handlers
Fuel Types: Natural Gas Units<10000 cfm:
Gas Pressure: Units>10000 cfm:
Furnaces Boilers&Compressors
Furnaces<100K BTU: 0-3 HP:
Furnaces>=100K BTU: 3-15 HP:
Floor Fumaces: 15-30 HP:
Unit Heaters: 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $165.20
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by callin• 503.232.1987 or 1.800.332.2344.
Issued By: d Permittee Signature: VV
Call 503.639.4175 by 7:00 a.m.for the next available inspection ite.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application
City of Tigard 1 ' ,f Received / ' P
13125 SW Hall Blvd.,Tigard,0 # s 13" _ Date/By: !�G�/�cj„Az(//�,( f ef.,2 )( -��/
_ Plan Review a J 4- __ t J 1/L 0'/1/L"/ /y)0/J
Phone: 503.7182439 Fax: 503.598.1,9�Q� � 2 2019 Date/By: { - (/ (/f/
T IC A Rig --
Inspection Line: 503.639.4175 JAN Date Ready/By: Jude: BI See Page 2 for
Internet: www.tigard-or.gov ( ,_ Notifi-�1ethod: Z ti A Supplemental Information
W.. .. ,. . . T` ' "01?'WO 1 C® �l1" ti�� !' � !€8I± t,'8T
�' ''` ` " Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
,,;, , , , , CAT oTtY O ijAtau 11 . Value:$$2,000 00
0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family ❑Master builder 0 Other: Description IQty. I Ea. I Total
4613 T 64 1 1�1 1i , 'T4?l Heating/cooling:
Air conditioning 46.75
Job site address:10310 SW Canterbury Lane Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: J Project name:WCCCA Canterbury Duct work 23.32
Cross street/directions to job site:From Tigard City Hall:Head south on SW Hydronic hot water system 23.32
Residential boiler(radiator or
Hall Blvd.Turn right onto SW McDonald St.Turn left onto SW 103rd Ave.Turn hydronic) 23.32
right onto SW Canterbury Lane.Destination will be on the left. Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: 1 Lot no.:02600 Other fuel appliances:
Tax map/parcel no.:2S111BC Water heater 23.32
Gas fireplace/insert 33.39
n t '°; Flue vent for water heater or gas
Install new fuel line between new propane tank and new generator. fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
23.32
t1Is'"-o si 4 i `KI4A l` , Other:
z .�. � ,.. 3 „
Environmental exhaust and ventilation:
Name:City of Tigard Public Works Range hood/other kitchen
Address:8777 SW Burnham Street equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)718-2591 Fax:( ) Attic/crawlspace fans 23.32
.w, ..4.. ., , ,f 4IEt4.0* _ >.,; p;,d Q111`lG *2PWO1
Other: 23.32
�'�' Fuel piping:
Business name:Washington County Consolidated Communications Agen $14.15 for first four;$4.03 for each additional
Contact name:Don Forsberg Furnace,etc.
Address:17911 NW Evergreen Place Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Beaverton,OR 97006 Water heater
Phone:(503)267-1947 Fax::( ) Fireplace
Range
E-mail:donforsberg45@gmail.com Barbecue
g- .-- p '4} ` :; :1 't... Clothes dryer(gas)
Business name:Day Management Corp. Other:
Address:4700 SE International Way Subtotal
City/State/ZIP:Milwaukie,OR 97222 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)659-1240 Fax:( ) State surcharge(12%of permit fee)
CCB lit.:64950 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Boa'
Print name:Don Forsbe Date:1-22-19
I:\BuildingTermits\MEC_PermitApp_040113.doc 440-4617r(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi Family Fee Schedule:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2